Post on 22-Feb-2016
description
EFFICACY OF SALIVARY GLAND AND LABIAL MUCOUS MEMBRANE
TRANSPLANTATION IN THE TREATMENT OF SEVERE SYMBLEPHARON AND DRY EYE
SECONDARY TO STEVENS-JOHNSON SYNDROME
Ana Estela BPP Sant´Anna, Rossen Harzarbassanov, Aline L Araújo, Tammy H Osaki, Midori H Osaki, Vera
LL Costa, Hellen PR Santos, Denise de Freitas, José AP Gomes
Federal University of Sao PauloVision Institute
Sao Paulo. SP. Brazil.
We do not have any financial interests or relationships to disclose
Stevens-Jonhson SyndromeStevens-Jonhson syndrome is an immunological disease that causes dry eye and severe cicatricial changes in the cornea, conjunctiva and eyelids.
Purpose
Evaluate salivary gland and labial mucous membrane transplantation in the treatment of patients with severe symblepharon and dry eye secondary to SSJ
Patients and Methods Design
Prospective interventional non-comparative case series Federal University of Sao Paulo. Sao Paulo. SP. Brazil.2006 -2009
Inclusion criteriaStevens-Johnson syndrome
○ Severe dry eyePrevious Schirmer I test = 0
○ Severe Symblepharon ○ Poor visual acuity
Steps of surgery: A. pre operative, B. obtaining mucous
membrane graft from inferior and superior lip with Ficas mucotome,
C. labial mucous membrane attached to the sclera,
D. obtaining the salivary glands,
E. fixing the salivary glands,
F. postoperative.
Results: Salivary Gland TransplantationCase Age/Sex Schirmer
Pre (mm)SchirmerPO (mm)
Visual acuity improvement
SymptomsImprovements
FU(months)
1. ANS 43♂ /0 /0 → ↑ 212. AAP 13♀ 0 1 ↑ ↑ 233. ALAJ 58♂ 0 2 → ↑ 54. CTO 18♀ 0 1 ↑ ↑ 275. CFS 52♂ 0 0 → ↑ 86. DMAA 41♀ 0 3 ↑ ↑ 207. FL 36♂ /0 /0 → ↑ 38. IG 45♀ 0 1 → ↑ 159. JLBS 10♂ 0 3 → ↑ 3510. LBS 13♂ 0 1 → ↑ 2611. LMC 31♂ 0 3 → ↑ 1512. LCPG 35♂ 0 4 ↑ ↑ 1313. MSA 37♀ 0 0 ↑ ↑ 1714. MPSN 16♂ 0 11 ↑ ↑ 2815. MLO 40♀ /0 /3 ↑ ↑ 2016. MRMS 24♀ /0 /3 → ↑ 1717. NRAO 17♀ /0 /0 ↑ → 2018. PAP 35♂ /0 /5 ↑ ↑ 3219. TMLL 35♀ 0 4 → ↑ 26
Results19 eyes (19 patients with SJS)
Age: 10-58 yo (mean 31 yo)FU time: 3-35 months (mean 19)
47% improvement of VA
Salivary Gland TransplantationFederal University of Sao Paulo
Sant´Anna & Gomes, 2009
Schirmer I test 14/19 patients (73%) 10 (52%) ≥ 2mm.
10 glands (p=0.0129)=increase tears
Group1
(Schirmer
=0mm)
Group2
(Schirmer
≤2mm)
Group3
(Schirmer
<2mm)
ϰ2 test P=
glands
(0-5)
66.67(2/3) 33.33(1/3) 0(0/3) 0.6065
glands
(5-10)
28.57(2/7) 28.57(2/7) 42.86(3/7) 0.1826
glands
(>10)
10(1/10) 20(2/10) 70(7/10) 0.0129
Schirmer I test versus transplanted salivary glands
52.6% improvement corneal transparency73.6% improvement corneal neovascularization
Grade 3 (%) Grade 4 (%) chi-squared or ϰ2 test
Pre Post Pre Post Pre Post
Transparency 0 (0/19)
10.53
(2/19)
15.79 (3/19)
63.16
(12/19)
84.21 (16/19)
26.32 (5/19)
0.0014
Neovascularization 0 (0/19)
10.52
(2/19)
5.26 (1/19)
26.33
(5/19)
94.74 (18/19)
63.15 (12/19)
0.0532
Pre Post
PostPre
Pre and postoperative.Notice the labial mucosa harvesting the entire sclera, at right.It looks like a new conjunctiva
PrePost
Conclusions Salivary gland and oral mucosa tp seems
to be efficient in treating severe dry eye 2ry to SJS and maybe improve the results of limbal SC tp
The procedure is reproducible and needs to be performed under general anesthesia
More cases and longer FU time are needed to further confirm our findings
anestela@uol.com.br